GIFT  OF 


NAVY  DEPARTMENT 
BUREAU  OF  MEDICINE  AND  SURGERY 


Regulations 


for  the 


Government  of  Naval  Districts 


of  the 


United  States 


(Medical  Department) 
June,  1917 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 
1917 


REGULATIONS  FOR  THE  GOVERNMENT  OF  NAVAL  DIS- 
TRICTS OF  THE  UNITED  STATES. 


Subject:  Regulations  for  the  government  of  naval  districts  of  the 

United  States  (instructions  governing  the  Medical  Department). 
References:  Chapter  46,  Naval  Instructions. 

FOR  MOBILIZATION. 

> 

1.  The  plans  for  the  organization  of  naval  districts  provide,  in 
part,  for  the  following  personnel  to  assist  the  commandant  in  the 
performance  of  his  duties : 

Medical  officer,  director  of  dispensary  service  (general). 

1.  Medical  officers  in  charge  of  dispensaries  at  bases 

and  stations  other  than  navy  yards  and  naval  sta- 
tions. 

2.  Hospital  Corpsmen. 

Medical  officer,  director  of  hospital  service  (central). 

1.  Supervisors  of  sick  in  other  than  naval  hospitals. 

2.  Hospital  Corpsmen. 

3.  Nurse  Corps,  regular,  reserve,  Naval  Reserve  Force, 

class  4. 
The  coast- defense  force  will  consist  of : 

A.  Commandant  of  the  naval  district. 

(a)  Assistant  commandant. 

(b)  Headquarters  staff. 

(c)  Commander  naval  forces. 

I.  Coast-defense  division. 
II.  District  scouts. 

(d)  Commander  of  section. 

I.  Officer  in  charge  of  section  patrols. 
II.  Officer  in  charge  of  naval  patrols. 

1.  Naval  patrol  stations. 

2.  Aircraft  stations. 

3.  Radio  stations. 

a 

363274 


4  GOVERNMENT   OF    NAVAL   DISTRICTS. 

' 
PERSONNEL,   AFFECTED   AND    INCLUDED. 

The  following  forces  and  personnel  will  be  mobilized  or  become, 
by  act  of  Congress,  presidential  or  other  order,  a  part  of  the  naval 
forces  and  will  require  medical  attention: 

A.  Navy. 

B.  Naval  Reserce  forces,  classes  1,  2,  3,  4,  5. 

C.  Naval  Militia  (National  Naval  Volunteers). 

D.  Coast  Guard. 

E.  Lighthouse  Service. 

F.  Coast  and  Geodetic  Survey. 

G.  Personnel   from   such   other   forces — Government,   municipal, 
civil,  or  private — as  may  become  a  part  of  the  naval  forces  for  the 
period  of  the  public  emergency. 

2.  The  following  instructions  are  issued  with  a  view  to  coordinat- 
ing, supervising,  and  providing  medical  service,  care,  and  treatment 
to  the  sick  and  wounded  of  the  personnel  of  all  the  forces  under  all 
circumstances,  to  be  effective  upon  the  issue  of  orders  for  mobilization. 

3.  [Enclosures  A,  B,  C,  D,  E  refer  to  the  cooperation  of  the  United 
States  Public  Health  Service  with  the  Medical  Department  of  the 
Navy  in  time  of  public  emergency ;  the  method  of  providing  medical 
relief  to  vessels  of  the  Coast  Guard  and  the  Lighthouse  Service ;  and 
to  vessels  of  the  Coast  and  Geodetic  Survey.    Inclosures  F,  G,  H,  and 
I  are  charts  and  matter  prepared  by  or  under  the  direction  of  the 
Bureau  of  Medicine  and  Surgery  or  of  the  United  States  Public 
Health  Service  with  reference  to  dispensary,  hospital,  quarantine, 
and  laboratory  facilities  (Government,  municipal,  and  private),  and 
may  be  obtained  from  the  Bureau  of  Medicine  and  Surgery  upon 
request  when  occasion  requires. 

Inclosures : 

A.  Correspondence   relative    to    cooperation    of   the   United 

.    States  Public  Health  Service  with  the  Medical  Depart- 
ment of  the  Navy  in  time  of  threatened  or  actual  war. 

B.  Executive  order  of  the  President,  April  3,  1917,  relative  to 

inclosure  A. 

C.  Public  Health  Service  circular  letter  of  instructions  to 

medical  officers. 

D.  Statement  relative  to  supplies  and  equipment  and  detail  of 

medical  officers  to  vessels  of  the  Coast  Guard. 

E.  Statement  relative  to  supplies  and  equipment  and  detail  of 

medical  officers  to  vessels  of  the  Coast  and  Geodetic 
Survey. 

F.  Schematic  chart   of   division    of   medical   service    (from 

Bureau  of  Medicine  and  Surgery  upon  request). 


GOVERNMENT  OF    NAVAL  DISTRICTS.  5 

G.  Blue-print  charts  of  section  bases,  civil  and  United  States 
Public  Health  Service  facilities  (obtained  from  Bureau 
of  Medicine  and  Surgery  upon  request). 

H.  Current  copy  of  Treasury  Department  publication  on 
contracts  for  the  care  of  seamen,  etc  (from  Bureau 
of  Medicine  and  Surgery  upon  request) . 

I.  List  of  stations  of  the  United  States  Public  Health  Service 
where  complete  facilities  are  available  for  disinfection, 
fumigation,  deratization,  etc. 

J.  Specimen  contract  for  use  in  connection  with  the  use  of 
the  facilities  of  civil  hospitals  and  other  institutions. 

K.  Proclamation  by  the  President  concerning  the  American 
National  Red  Cross  activities  in  time  of  war. 

L.  Certain  instructions  concerning  records  and  reports  and 
returns  on  various  personnel  and  blank  forms. 

M.  Deaths  and  disposal  of  remains. 

4.  Upon  the  existence  of  threatened  or  actual  war  the  Bureau  of 
Medicine  and  Surgery  will  recommend  that  the  cooperation  of  the 
United  States  Public  Health  Service  with  the  Medical  Department 
of  the  Navy  be  obtained,  and  that  the  Secretary  of  the  Navy  make 
request  upon  the  Secretary  of  the  Treasury  that  authority  be  granted 
for  the  Medical  Department  of  the  Navy  to  avail  itself  of  the  utili- 
ties and  facilities  to  be  had  at  certain  hospitals,  quarantine  and  other 
stations  of  the  United  States  Public  Health  Service  for  the  care  and 
treatment  of  sick  and  wounded  from  ships  and  stations  of  the  Navy ; 
and  that  the  Medical  Department  of  the  Navy  be  authorized  to  direct 
the  transfer  of  such  sick  and  wounded  patients  to  the  nearest  hos- 
pital, quarantine  or  other  station  of  the  United  States  Public  Health 
Service  when  emergency  or  urgent  necessity  demands;  and:  further, 
that  the  health  records,  sick  reports,  medical  surveys,  etc.,  be  kept 
and  made  out  by  officers  of  the  United  States  Public  Health  Service 
attached  to  the  above-mentioned  stations,  such  officers  to  be  directed 
by  proper  authority  to  assist  in  the  proper  execution  of  Navy  and 
Marine  Corps  records. 

5.  The  United  States  Public  Health  Service  will  see  to  it  that  such 
hospitals  and  stations  as  might  be  used  for  the  care  of  the  sick  of  the 
naval  personnel  are  thoroughly  equipped,  put  in  order,  repaired, 
such  additions  and  extensions  as  may  be  necessary  made,  and  that 
equipment  and  supplies  may  be  available  to  make  these  hospitals 
and  stations  ready  to  meet  possible  demands  upon  them. 

6.  The  Bureau  of  Medicine  and  Surgery  will  avail  itself  of  offices 
of  the  United  States  Public  Health  Service  having  to  do  with  matters 
pertaining  to  the  control  of  biological  products,  comprising  periodic 
inspections  of  commercial  establishments,  laboratory  examinations 
of  their  products  and  researches  in  respect  to  standards  and  other 


6  GOVERNMENT   OF   NAVAL  DISTRICTS. 

matters  affecting  the  purity  and  potency  of  these  products,  examina- 
tion and  preparation  of  viruses,  serums,  and  toxins,  etc.,  serological, 
Wassermann,  and  Noguchi  examinations,  various  reports  of  the  serv- 
ice on  diseases,  water  analyses,  and  general  sanitation. 

7.  Communications  sent  to  a  marine  hospital  should  be  addressed  to 

the  "Medical  Officer  in  Charge,  U.  S.  Marine  Hospital, " 

and  those  sent  to  second  or  third  class  stations  to  the  "  Medical  Offi- 
cer in  Charge,  U.  S.  Public  Health  Service, " 

MEDICAL    ATTENTION    RENDERED    AND    SUPPLIES    FURNISHED    THE    COAST 
GUARD    AND    LIGHTHOUSE    ESTABLISHMENTS. 

8.  The  Coast  Guard  and  the  Lighthouse  Service,  so  far  as  the  per- 
sonnel and  medical  supplies  are  concerned,  will  receive  medical  at- 
tention and  medical  stores  and  supplies  as  heretofore  provided  by  or 
under  the  direction  of  the  United  States  Public  Health  Service.    Ad- 
ditional Navy  medical  officers  will  be  detailed  where  necessary  to 
replace,  augment,  or  fill  vacancies  for  medical  officers  of  the  United 
States  Public  Health  Service. 

9.  "Hereafter  whenever  in  accordance  with  law  the  expenses  of 
the  Coast  Guard  are  paid  by  the  Navy  Department  any  naval  appro- 
priations shall  be  reimbursed  from  available  appropriations  made 
by  Congress  for  the  expenses  of  the  Coast  Guard."    Upon  request 
payment  will  be  made  for  medical  supplies  furnished  vessels  of  the 
Coast  Guard  from  the  regular  appropriation  of  the  Coast  Guard  by 
a  transfer  of  funds.     Regular  appropriations  made  for  the  Coast 
Guard  Service  will  continue  in  force  while  available,  and  naval  ap- 
propriations will  only  be  used  when  Coast  Guard  appropriations 
shall  have  been  exhausted.     It  is  desirable  so  far  as  possible  not  to 
disturb  normal  conditions  except  where  absolutely  necessary.    It  is 
therefore  understood  that  vessels  of  the  Coast  Guard  will  continue 
to  secure  medical  supplies  while  cooperating  with  the  Navy  in  the 
same  manner  as  heretofore.     Subsequently  when  Coast  Guard  ap- 
propriations shall  have  been  exhausted,  while  the  Coast  Guard  is  a 
part  of  the  Navy,  the  Bureau  of  Medicine  and  Surgery  will  furnish 
vessels  of  the  Coast  Guard  with  medical  supplies  upon  requisition 
therefor  being  made  to  that  bureau.    Medical  supplies  so  requested 
will  be  allowed  only  in  same  amount  as  is  allowed  vessels  of  the  Navy 
of  similar  size  and  complement.     (See  Bureau  of  Medicine  and  Sur- 
gery letter  127847,  of  Apr.  18,  1917,  and  indorsements  from  Bureau 
of  Supplies  and  Accounts  and  Captain  Commandant  Coast  Guard.) 

10.  When  vessels  of  the  Lighthouse  Establishment  are  transferred 
to  operate  as  a  part  of  the  naval  forces  "  after  such  transfer  all  ex- 
penses connected  therewith  shall  be  defrayed  out  of  the  appropria- 
tions for  the  department  to  which  transfer  is  made." 


GOVERNMENT  OF   NAVAL  DISTRICTS.  7 

11.  The  Coast  and  Geodetic  Survey,  so  far  as  personnel  and  medical 
supplies  are  concerned,  will  receive  medical  attention  and  medical 
stores  and  supplies  as  heretofore  provided  (see  inclosure  E) ;  addi- 
tional medical  attention,  services,  and  supplies  to  be  provided  in  such 
a  manner  as  may  become  expedient. 

12.  Personnel  coming  within  paragraph  1,  G  above  will  be  pro- 
vided for  as  circumstances  indicate. 

MEDICAL,  SERVICE. 

13.  Medical  service  will  be  rendered  under  two  general  divisions — 
dispensary  service  (general)  and  hospital  service  (central). 

(a)  Dispensaries  or  quarters  for  the  temporary  housing  and  care 
of  patients  ashore  and  afloat  will  be  established  at  section  bases  for 
patrol  forces  and  at  other  outlying  stations   (such  as  aero,  radio, 
recruit  depots  and  camps)  within  the  district. 

(&)  The  naval  hospital,  together  with  such  necessary  adjuncts, 
located  at  the  permanent  naval  base  will  constitute  the  naval  hos- 
pital base  for  the  care,  treatment,  and  disposition  of  all  patients 
requiring  hospital  care. 

DIRECTORS    OF    MEDICAL    SERVICE. 

14.  (a)  MEDICAL  OFFICER;  DIRECTOR  OF  DISPENSARY  SERVICE. — The 
medical  aid  to  the  commandant:  It  is  desired,  so  far  as  this  bureau 
is  concerned,  that  the  senior  medical  officer  at  the  navy  yard  or 
station  be  designated  the  medical  aid  to  the  commandant  herein 
provided,  he  to  have  general  charge  of  all  dispensary  service. 

(b)  MEDICAL   OFFICER;   DIRECTOR  OF  HOSPITAL   SERVICE,   NAVAL 
HOSPITAL  BASE. — Medical   officer   in   command   of   naval   hospital, 
medical  director  of  hospital  service  at  naval  hospital  base  at  per- 
manent naval  base:  It  is  desired,  so  far  as  the  bureau  is  concerned, 
that  the  medical  officer  in  command  of  the  naval  hospital  will  con- 
sider himself  in  charge  (as  medical  director)  of  the  hospital  service 
of  the  naval  hospital  base  located  at  the  permanent  naval  base. 

ADDITIONAL  MEDICAL  OFFICERS'  ASSISTANTS. 

15.  Such  medical  officers  as  may  be  required  to  assist  the  medical 
aid  in  the  performance  of  his  duties;  to  act  as  medical  officer  in 

charge  of  section  base    (or  station)    dispensary;  to  be  in 

charge  of  reception  and  distributing  stations  and  transportation; 
or  as  may  be  otherwise  required,  will  be  detailed  for  duty  within 
the  district. 

The  commandant  of  the  district  will  issue  the  necessary  orders 
authorizing  the  district  medical  officer  to  provide  medical  assist- 
ance and  supplies  and  instructions. 


8 

Such  medical  officers  of  the  regular  staff  of  the  naval  hospital 
or  such  additional  medical  officers  as  may  be  required  for  duty 
as  supervisors  of  sick  in  other  than  naval  hospitals  will  be  detailed 
from  the  naval  hospital  or  other  source  for  duty  within  the  district. 

Patients  of  the  Navy  and  Marine  Corps  under  treatment  at  Public 
Health  Service  stations  and  civil  institutions  shall  comply  with 
all  rules  and  regulations  of  these  institutions  and  the  directions 
of  the  officer  or  superintendent  in  charge  and  shall  conduct  them- 
selves in  a  similar  manner  as  though  residents  of  the  naval  hos- 
pital (to  which  they  are  officially  attached)  and  shall  be  reported 
and  disciplined  by  proper  authority  for  any  and  all  infractions 
of  rules,  regulations,  and  deportment  consistent  with  the  further- 
ance of  the  best  interests  of  the  Medical  Department  and  Service, 
and  in  compliance  with  the  Navy  Regulations  in  respect  to  these 
conditions. 

DISPENSARY  SERVICE   (GENERAL). 

16.  The  officer  in  charge  of  this  service  shall  have  general  super- 
vision of  all  dispensary  service  within  the  naval  district.  He  shall 
be  responsible  for  the  proper  organization,  establishment,  and  equip- 
ping of  suitable  medical  and  surgical  facilities  in  the  nature  of  dis- 
pensaries or  quarters  for  the  temporary  housing  and  care  of  patients 
at  section  bases  for  patrol  forces  and  other  outlying  stations  (such 
as  aero,  radio  stations,  recruit  depots  and  camps,  etc.),  and  for  the 
medical  care  of  the  personnel  of  the  Navy,  Regular,  Reserve,  and 
Volunteer,  within  the  district  and  not  attached  to  navy  yards  or 
stations  otherwise  provided  for. 

He  shall  exercise  general  supervision  over  all  naval  medical  ac- 
tivities in  the  district,  except  naval  hospitals,  such  as  the  coordina- 
tion and  direction  of  the  work  of  the  medical  officers  in  charge  of 
section  base  and  other  outlying  station  dispensaries.  He  shall  direct 
the  preparation  of  requisitions  for  proper  medical  outfit;  for  the 
units  of  dispensary  service  within  his  district;  the  furnishing  of 
patrol  boats  with  boat  boxes;  the  furnishing  of  larger  "mother" 
boats  operating  with  patrol  boats  with  a  standard  medicine  box,  etc., 
obtaining  and  detailing  adequate,  competent,  personnel  for  stations 
and  boats. 

He  should  prepare  for  issue  to  all  commanding  and  medical  officers 
of  patrol  boats  (and  other  vessels  as  necessary)  instructions  and 
information  concerning  medical  service  and  the  disposition  of  pa- 
tients of  the  dispensary  service  and  for  further  transfer  to  the  Naval 
Hospital  Base. 

He  should  inform  the  Bureau  of  Medicine  and  Surgery  of  the  num- 
ber oi  medical  officers  he  desires  sent  to  him  in  addition  to  the  offi- 


GOVERNMENT  OF   NAVAL  DISTRICTS.  9 

cers  of  the  Regular  service,  Reserve  Force,  and  Militia  then  on  duty, 
to  undertake  the  activities  of  the  yard  and  the  various  dispensaries. 

The  medical  officer  should  call  upon  the  commandant  for  enroll- 
ment of  all  necessary  clerical  assistance  needed  in  his  office. 

As  soon  as  practical  the  bureau  should  be  informed  of  the  probable 
maximum  personnel  of  the  district  so  that  proper  hospital  facilities 
may  be  afforded  to  take  care  of  them. 

All  sick  who  can  not  be  sent  to  duty  within  a  few  days  should  be 
sent  to  nearest  naval  hospital,  as  soon  as  able  to  travel  and  transpor- 
tation is  available.  When  sent  in  any  number  the  naval  hospital 
should  be  notified  in  advance  of  th^ir  arrival. 

He  should  make  all  provisions  required  by  naval  regulations  and 
instructions  and  Manual  for  Medical  Department  for  the  prepara- 
tion, verification,  care  in  keeping,  custody  and  disposition  of  health 
records,  statistical  reports  and  returns. 

He  should  maintain  close  relations  and  cooperation  with  the  medi- 
cal officer  in  command  of  each  naval  hospital  within  the  district 
(director  of  hospital  service,  naval  hospital  base  at  permanent  naval 
base). 

It  is  intended  that  the  medical  officer  located  at  the  headquarters 
of  the  commandant  of  the  naval  district  will  act  as  the  medical  aid 
for  the  district.  In  such  places  as  Annapolis,  Md.,  Washington, 
D.  C.,  Portsmouth,  N.  H.,  it  will  be  necessary  to  use  the  permanent 
establishments  as  section  bases  and  for  the  medical  and  commanding 
officers  of  such  stations  to  cooperate  with  the  commandant  of  the  dis- 
trict and  his  medical  aid  in  affording  medical  service  not  only  as  a 
section  base  but  as  a  permanent  base. 

At  those  places  where  no  Government  facilities  are  at  hand  pa- 
tients may  be  placed  temporarily  in  civil  institutions  to  be  sent  as 
soon  as  practicable  to  the  nearest  marine  or  naval  hospital. 

Where  the  services  of  naval  medical  officers  are  not  available, 
officers  and  men  attached  to  a  naval  district  may  receive  office  treat- 
ment from  officers  of  the  United  States  Public  Health  Service  in  the 
vicinity. 

Officers  and  enlisted  men  of  naval  districts  requiring  immediate 
hospital  treatment,  where  naval  hospitals  are  not  available,  are 
entitled  to  admission  to  a  hospital  of  the  United  States  Public 
Health  Service  (Marine  Hospital)  ;  requests  by  commanding  officers 
or  enlisted  men  in  charge,  made  directly  upon  the  hospital,  will  be 
sufficient  for  this  purpose.  No  payments  will  be  made  for  either 
office  or  hospital  service,  as  all  such  charges  are  adjusted  between  the 
United  States  Public  Health  Service  and  the  Bureau  of  Medicine 
and  Surgery. 

Where  medical  services  can  not  be  obtained  from  either  naval  or 
public  health  sources,  or  when  transportation  to  one  or  the  other  is 
106637—17 2 

\ 


10  GOVERNMENT   OF    NAVAL  DISTRICTS. 

not  practicable,  or  in  cases  of  sudden  emergency,  a  civilian  physician 
may  be  employed,  or  admission  to  a  civiiian  hospital  may  be  au- 
thorized by  the  commanding  officer  or  enlisted  man  in  charge,  and 
reported  as  required  by  Article  4535  (5)^(6),  Navy  Regulations. 
Vouchers,  completely  certified,  will  be  submitted  to  the  Bureau  of 
Medicine  and  Surgery  through  official  channels. 

Such  additional  instructions  and  information  as  may  be  con- 
sidered necessary  concerning  this  medical  ^service  will  be  prepared 
for  issue  under  the  direction  of  the  contn\andant  of  the  district 
concerned.  /•< 

•^ 

DUTIES    OF    MEDICAL    OFFICER    IN    CHARGE"  OF    DISPENSARY. 

17.  The  duties  of  the  medical  officer  in  cl^a.fge  of  the  section  base 
dispensary  should  be  to  make  a  preliminary  survey  of  the  locality, 
landing,  and  docking  facilities,  and  select  suitable  quarters  for  the 
dispensary.     He  should  proceed  without  delay  to  establish  and  equip 
his  station  and  make  report  to  the  proper  authorities,  submit  requi- 
sitions, and  receipt  for  stores,  obtain  by  recommendation  proper  per- 
sonnel, etc.,  and  to  make  such  other  arrangements  as  in  his  judgment 
are  required  for  the  particular  station.     He  should  familiarize  him- 
self with  all  charts,  instructions,  and  information  concerning  the 
particular  section  base  and.  its  immediate  hospital  base,  or  the  sec- 
tion base  furnished  him  by  the  commandant  or  the  bureau.     He 
should  give  emergency  care  and  treatment  to  all  patients  sent  to  the 
dispensary  and  direct  their  transfer,  if  necessary,  to  the  main  base 
hospital.    He  should  also  provide  local  means  of  transportation  and 
also  transportation  from  any,  dispensary  to  the  hospital  base,  deter- 
mining what  use  may  be  made  of  available  vehicles,  boats,  etc.,  be- 
longing to  private  parties  or  local  residents.    He  should  keep  proper 
records  of  all  work  and  patients  and  make  suitable  entries  in  all 
health  and  service  records  and  return  them  to  the  ship  or  forward 
them  to  the  hospital  to  which  the  pateint  is  sent.    He  should  confer 
with  the  medical  aid  whenever  necessary  upon  all  matters  within 
his  purview,  and  at  all  times  comply  with  the  directions  and  instruc- 
tions issued  by  the  medical  aid  through  the  commandant. 

ESTABLISHMENT  OF  DISPENSARY. 

18.  At  those  places  where  section  bases  have  been  located  from 
which  naval  district  forces  are  to  operate  and  at  such  other  places  as 
necessary   within   the  naval   district,   there   should  be  established 
within  the  base  or  station  or  its  immediate  vicinity  a  dispensary  for 
the  reception,  treatment,  and  immediate  or  remote  disposition  of  the 
sick  and  wounded; 


GOVERNMENT  OF   NAVAL  DISTRICTS.  11 

So  far  as  practicable  the  dispensary  should  be  situated  at  the  best 
place  for  the  landing  of  patients. 

The  dispensary  should  consist  of  a  small  building  or  one  or  several- 
rooms  in  a  building  of  a  suitable  size  and  character,  depending  upon; 
the  personnel  to  be  served,  having  adequate  facilities  for  the  installa- 
tion of  proper  ventilation,  heating  and  lighting  devices,  etc.,  for 
possible  arrangement  into  offices,  reception,  and  emergency  operating 
rooms,  wards,  toilets,  kitchens,  etc.,  where  rational  first  aid  and  neces- 
sary operations,  etc.,  may  be  conducted  and  where  patients  whose 
condition  or  injuries  prevent  their  removal  may  be  retained  until 
such  time  as  they  may  be  fit  for  transfer  to  a  hospital  at  the  perma- 
nent naval  base  or  may  be  given  temporary  treatment  for  a  few  days 
with  a  view  to  returning  them  to  duty. 

The  local  facilities  of  the  United  States  Public  Health  Service 
preferably  or  in  their  absence  of  a  civil  hospital  may  be  utilized 
temporarily  or  continuously  in  preference  to  opening  a  station,  at  the 
discretion  of  the  medical  aid.  Where  it  would  appear  more  practi- 
cable and  economical,  an  office  dispensary  only  need  be  established 
and  a  near-by  marine  hospital  or  civil  hospital  may  be  used  to  pro- 
vide ward  and  operating  room,  etc.,  facilities. 

EQUIPMENT  AND   SUPPLIES. 

19.  Such  suitable  supplies  and  equipment  as  may  be  necessary,  the 
character  and  amount  depending  upon  the  presence  of  medical  officer 
or  hospital  corpsman,  number  of  men  to  be  cared  for,  facilities  for 
establishing  a  dispensary,  proximity  of  an  available  hospital  to 
which  patients  may  be  sent,  etc.,  will  be  provided  for  each  dispensary 
or  station. 

Requisitions  for  supplies,  etc.,  and  medical  outfits  are  to  be  pre- 
pared by  the  medical  aid  or  by  his  representative  or  the  respective 
dispensary  medical  officer  and  forwarded  to  the  Bureau  of  Medicine 
and  Surgery  after  it  has  been  reviewed  by  the  medical  aid  and  has; 
been  approved  by  him.  When  requisitions  for  equipping  stations 
are  forwarded  they  must  be  accompanied  by  a  statement  of  the 
number  of  men  to  be  served  by  the  dispensary,  the  facilities  available 
for  their  care,  facilities  for  opening  the  dispensary  under  a  roof,  and 
the  arrangements  that  have  been  perfected  for  the  transfer  of  pa- 
tients to  hospital.  Special  instructions  with  the  regard  to  the  ship- 
ment of  stores  to  the  best  advantage  in  so  far  as  railroad,  water, 
motor,  or  other  means  is  concerned  should  also  be  stated. 

Boat  boxes  should  be  secured  by  the  medical  aid  at  headquarters 
in  a  sufficient  number  to  provide  each  patrol  boat  or  for  distribution 
to  boats  as  required.  (Use  Form  4  M.  &  S.)  (Section  commanders 
should  see  that  patrol  boats  in  their  sections  are  equipped  with  these 
boxes.) 


12  GOVEENMENT   OF    NAVAL   DISTRICTS. 

Medicine  boxes  should  be  secured  by  the  medical  aid  at  head- 
quarters with  which  to  equip  each  parent  or  "  mother  "  boat  if  pres- 
ent. To  large  patrol  boats  having  complements  in  excess  of  20  men 
should  be  issued  a  medicine  box  if  considered  necessary.  (See  Sup- 
ply Table,  p.  30). 

In  order  to  conserve  medical  supplies  and  boat  boxes  only  such 
stores  and  boxes  as  are  actually  required  for  the  present  usage  should 
be  requisitioned  for.  Due  economy  should  be  exercised  in  these 
matters. 

The  use  of  Form  B  or  other  medical  requisitions  by  other  than 
medical  officers  under  the  supervision  of  the  medical  aid  is  not  desired 
nor  practicable. 

RECEPTION   OF   PATIENTS   AT  DISPENSARIES. 

20.  Such  sick  and  wounded  as  the  medical  department  of  a  patrol 
boat  is  unable  to  care  for  will  be  transferred  to  the  care  of  the  dis- 
pensary of  the  section  base  or  station  for  further  transfer,  if  neces- 
sary, to  the  naval  base  hospital. 

A  vessel  of  the  naval  district  forces  having  sick  or  injured  on 
board,  may  proceed  to  the  nearest  section  base  or  station  dispensary 
and  turn  over  all  patients  to  the  medical  officer  in  charge  of  the 
section  base  dispensary.  All  papers  and  health  records  belonging 
to  the  patients  should  be  left  with  him  at  this  station.  If  but  tem- 
porary rest  and  treatment  are  required,  the  patient  may  be  returned 
to  duty,  when  thought  practicable,  direct  from  this  point.  If,  how- 
ever, such  is  not  the  case,  patients  will  receive  such  treatment,  medi- 
cal or  surgical,  in  the  way  of  medicines,  surgical  dressings,  minor 
or  emergency  operation,  as  is  deemed  wise  or  sufficient  to  safeguard 
life  and  make  early  convalescence  possible.  Those  who  are  unable 
to  be  moved  further  shall  be  retained  and  carefully  attended  until 
transfer  becomes  feasible  and  possible.  As  soon  as  considered  able 
to  travel,  and  transportation  is  available,  all  patients  who  require 
further  hospital  treatment  or  long-drawn-out  treatment  at  a  hospi- 
tal, are  to  be  evacuated  to  the  nearest  naval  hospital  at  the  perma- 
nent naval  base.  If  it  is  impracticable  to  transfer  patients  to  the 
nearest  naval  hospital,  a  hospital  of  the  Public  Health  Service  will 
be  made  use  of.  The  transfer  of  patients  should  be  effected  with  the 
greatest  comfort  to  the  patient,  and  provisions  made  so  that  his 
injury  may  not  be  aggravated,  and,  should  it  be  necessary,  attendants 
for  the  journey  shall  be  provided. 

The  medical  aid  or  his  representative  and  the  medical  officer  in 
charge  of  the  section  base  or  station  dispensary  will  be  in  charge 
and  responsible  until  patients  are  delivered  to  the  hospital  service  at 
the  permanent  naval  base. 


GOVERNMENT   OF   NAVAL  DISTRICTS.  13 

TRANSPORTATION. 

21.  The  medical  aid  should  establish,  if  practicable,  at  a  convenient 
place  suitably  located  with  reference  to  wharves  and  railroad  sta- 
tions, a  station  for  the  reception  and  distribution  of  patients  coming 
from  the  various  district  dispensaries  en  route  to  the  naval  hospital 
base. 

Transportation. — Transportation,  both  local  and  central  and  be- 
tween the  local  and  central  points,  shall  be  under  the  charge  of  the 
medical  aid  to  the  commandant.  Locally  the  medical  officer  in 
charge  of  the  section  base  shall  be  in  charge  of  his  local  transporta- 
tion. Between  the  section  base  and  the  central  base  the  medical  aid  to 
the  commandant  should  provide  means  of  transportation  and  familiar- 
ize himself  with  the  possible  means  of  transportation  available  be- 
tween the  section  bases  and  his  reception  station.  It  should  be  his 
duty  to  acquaint  the  medical  officers  in  charge  of  section  bases  with 
the  opportunities  for  transportation,  both  by  Government  means, 
boat,  train,  automobiles,  etc.,  make  special  provision  for  the  trans- 
portation of  patients  in  large  numbers,  and  make  provision  for  the 
proper  delivery  of  patients  to  the  naval  hospital  at  the  permanent 
naval  base.  He  should  further  inform  the  naval  hospital  of  the 
number  of  patients  about  to  arrive  for  hospital  treatment  at  such 
time  in  advance  of  the  arrival  of  the  patients  as  will  permit  the 
hospital  to  provide  suitable  accommodations  for  these  patients,  to 
evacuate  to  other  hospitals,  etc.  In  connection  with  the  transporta- 
tion locally  at  the  permanent  naval  base  he  should  confer  with  the 
medical  officer  in  command  of  the  naval  hospital  base  with  regii  rd  to 
transportation  of  patients  from  a  naval  hospital  to  the  adjuncts 
thereto. 

MEDICAL  DEPARTMENT  RECORDS. 

22.  When  patients  are  put  ashore  at  a  section  base  dispensary  all 
papers,  service,  and  health  records  should  accompany  each  patient. 
The  medical  officer  should  take  charge  of  these  records,  make  proper 
entries  and  forward  them  to  the  proper  administrative  office  of  the 
district.    The  health  record  should  be  retained  and  forwarded  with 
the  patient  to  the  naval,  marine,  or  civil  hospital,  as  the  case  may  be, 
to  which  the  patient  is  transferred.    Upon  return  to  duty  the  health 
record  should  be  returned  direct  from  the  dispensary  together  with 
the  man.     The  dispensary  should  send  to  the  bureau  in  each  case, 
when  the  patient  is  discharged  to  hospital,  discharged  to  duty,  or 
otherwise  disposed  of,  a  Form  F  card,  rough,  for  the  files  of  the 
bureau,  retaining  the  duplicate  copy.    The  bureau  will  then  make  up 
Forms  F  and  K,  as  the  case  may  be,  at  the  bureau.    No  additional 
report  need  be  made  to  the  bureau  in  the  matter. 


14  GOVERNMENT  OP   NAVAL  DISTRICTS. 

HOSPITAL  SERVICE    (CENTRAL). 

23.  The  officer  in  charge  of  this  service  shall  have  general  supervi- 
sion of  the  hospital  service  of  the  naval  hospital  base  located  at  a  per- 
manent naval  base.  He  shall  be  responsible  for  the  development 
of  the  maximum  hospital  facilities  at  the  permanent  naval  base. 
He  should  prepare  comprehensive,  well-organized,  and  systematic 
plans  and  arrangements  (in  the  way  of  understandings  and  agree- 
ments with  local  institutions — Public  Health  Service,  municipal,  and 
private)  for  the  most  expeditious  and  rational  transportation,  dis- 
tribution, and  disposition  of  patients  sent  to  the  naval  hospital  base, 
and  for  the  supervision  of  the  care  of  the  sick  and  wounded  in 
near-by  civil  hospitals,  convalescent  homes,  or  other  institutions, 
when  employed  in  part  or  as  a  whole  as  an  annex  or  adjunct  to  the 
established  naval  hospital,  preference  being  given  to  the  hospitals, 
quarantine  stations,  or  other  facilities  of  the  United  States  Public 
Health  Service  in  evacuating  the  naval  hospital.  He  should  obtain 
a  daily  report  of  available  and  unoccupied  beds  at  the  naval  hospital 
base  and  make  provisions  for  the  evacuation  of  all  hospitals  of  con- 
valescent patients  to  places  inland,  to  their  homes,  etc.,  in  order  that 
beds  may  be  available  for  acute  cases  and  emergencies.  He  will 
arrange  proper  landing  and  reception  facilities  for  patients  on 
wharves  or  at  railroad  terminals  suitable  for  such  work  and  as  near 
as  possible  and  practicable  to  the  center  of  his  field  of  service  in  the 
permanent  naval  base. 

He  should  familiarize  himself  with  the  transportation  facilities 
available  and  prepare  a  list  of  sources  of  supply  of  vehicles  which  he 
may  requisition  in  emergency  for  such  transportation. 

He  should  inform  the  bureau  from  time  to  time  of  the  number  of 
medical  officers  that  lie  considers  necessary  and  desires  to  have  de- 
tailed to  his  command  in  addition  to  the  officers  of  the  regular  serv- 
ice, reserve  force,  and  militia  now  on  duty  there,  to  act  as. assistants 
or  supervisors  of  sick  in  civil  hospitals,  etc.,  and  for  the  proper 
execution  of  the  activities  of  the  naval  hospital  base. 

He  should  also  inform  the  bureau  of  the  number  of  nurses  and 
attendants,  both  male  and  female,  required  for  the  care  of  patients, 
etc.,  in  the  naval  hospital  and  its  outbuildings,  temporary  buildings, 
and  tent  wards. 

He  should  make  the  necessary  arrangements  for  the  employment 
of  all  necessary  civil,  clerical,  and  other  assistants  needed  in  his 
offices. 

He  should  make  all  provisions  required  by  the  Naval  Regulations 
and  Instructions  and  Manual  for  Medical  Department  for  the  prepa- 
ration, verification,  care  in  keeping,  custody,  and  disposition  of 
health  records,  statistical  reports  and  returns,  and  all  official  and 
unofficial  correspondence,  etc. 


GOVEBNMENT  OF   NAVAL  DISTEICTS.  15 

He  will  have  general  supervision  over  the  requisitions  for  and  dis- 
position of  all  medical  supplies,  stores,  and  equipment  for  the  hos- 
pital service. 

He  should  maintain  close  relations  and  cooperation  with  the  medi- 
cal aid  to  the  commandant  (director  of  dispensary  service). 

SUPERVISORS  OF  SICK. 

24.  Supervisors  of  sick  will  be  detailed  to  all  hospitals  or  other  in- 
stitutions other  than  naval  hospitals  where  Navy  patients  are  cared 
for,  as  representatives  of  the  medical  director  of  the  hospital  service, 
the  number  of  officers  and  the  duty  assigned  to  each  to  be  at  the  dis- 
cretion of  the  director. 

A  supervisor  may  have  charge  of  patients  in  one  or  more  hospitals. 

The  duties  of  these  supervisors  of  sick  should  be  to  have  general 
charge  of  the  care  and  comfort  of  the  sick,  keep  the  medical  records, 
perform  the  purely  naval  duties  in  connection  with  the  care  of  the 
sick,  be  held  responsible  for  the  enforcement  of  discipline  through 
the  proper  authorities,  recommend  leave,  medical  surveys,  discharge 
from  the  service  or  to  duty,  etc.,  of  such  patients  as  may  be  under  his 
supervision.  The  supervisor  should  also  make  statistical  returns, 
P"orm  F  rough,  Form  F  smooth,  Forms  G,  H,  I,  K,  M,  N,  P,  to  the 
central  administrative  offices  of  the  naval  hospital. 

DEVELOPMENT  OF   NAVAL   HOSPITAL  BASE. 

25.  The  naval  hospital  located  at  the  permanent  naval  base  will  act 
as  the  main  and  administrative  base  hospital.    To  provide  for  over- 
flow of  patients  received  in  excess  of  accommodations  of  the  hos- 
pital building,  adjoining  or  near-by  Government-owned  buildings 
capable  of  conversion  to  hospital  uses,  buildings  of  a  temporary  or 
semipermanent  character,  or  tents  should  be  obtained  and  fitted  for 
the  purpose.    To  provide  further  for  the  care  of  patients  in  large 
numbers  certain  adjuncts  should  be  available,  these  to  consist  of 
a  marine  hospital,  a  Public  Health  Service  quarantine  station,  or 
other  facilities,  including  Red  Cross  hospitals,  civil  hospitals,  and 
institutions,  insane  hospitals,  convalescent  homes,  estates  offered  as 
recuperative  residences,  etc.    In  the  main  the  facilities  of  the  United 
States  Public  Health  Service  will  be  utilized  in  preference  and  prior 
to  civil  institutions.    These  adjuncts  may  be  expected  to  undertake 
the  care  of  such  acute  or  emergency  cases  as  are  sent  to  them,  the 
staff  of  civil  physicians  regularly  conducting  the  care  of  patients 
within  the  hospital  performing,  in  so  far  as  practicable,  the  opera- 
tions necessary  and  providing  the  after  treatment  with  the  consent  of 
the  medical  director  or  his  representative.    These  adjuncts,  however, 


16  GOVERNMENT   OF    NAVAL  DISTRICTS. 

may  be  expected  to  act  only  in  the  capacity  of  evacuation  hospitals, 
this  to  depend  upon  military  circumstances  and  necessity,  the  char- 
acter of  the  hospital  or  institution,  the  facilities  at  hand  for  the  care 
of  patients,  and  its  location  with  regard  to  the  immediate  or  remote 
relation  to  the  naval  hospital. 

With  the  authorities  of  such  civil  hospitals  and  institutions  as  are 
desired  as  adjuncts  the  medical  director  should  undertake  to  make 
clearly  understood  arrangements  and  agreements  for  the  care  of 
such  patients  as  he  may  find  it  necessary  to  send  to  them  and  should 
obtain  bids  and  execute  contracts  to  meet  all  expenses  incident  to  the 
care  of  such  patients  upon  a  per  capita  per  diem  basis  and  in 
accordance  with  specimen  contract  herein  shown  as  inclosure  J. 

SUPPLIES   AND  EQUIPMENT. 
I 

26.  All  requisitions  for  equipment  and  supplies  shall  be  prepared 
under  the  supervision  of  the  medical  director  and  shall  be  submitted 
only  by  him  or  his  authorized  representative. 

Only  such  equipment  and  supplies  as  shall  be  required  for  the 
established  naval  hospital  and  for  such  adjacent  buildings,  tem- 
porary structures,  and  tent  wards  as  are  operated  as  immediate  facili- 
ties for  expansion  (within  the  hospital  grounds  or  the  navy  yard  or 
station)  shall  be  requisitioned  for.  No  supplies,  equipment,  tent- 
age,  etc.,  will  be  distributed  to  civil  hospitals  or  institutions,  and 
all  requests  therefrom  for  such  supplies  and  equipment  shall  be 
referred  to  the  Bureau  of  Medicine  and  Surgery.  Adequate  supplies 
and  dressings  shall  be  kept  on  hand  at  all  tunes,  but  no  effort  should 
be  made  to  overstock  beyond  reasonable  limits,  in  order  that  stores  at 
supply  depots  may  be  conserved  and  used  to  best  advantage  to  the 
service  at  large. 

RECEPTION  AND  DISPOSITION  OF  PATIENTS  AT  THE  NAVAL  HOSPITAL  BASE. 

27.  The  naval  hospital  base  will  receive  from  all  sources  all  naval 
patients  requiring  hospital  care  or  prolonged  treatment,  their  segre- 
gation, distribution,  and  disposition  to  be  directed  by  the  medical 
director  to  such  hospitals,  institutions,  and  places  as  he  considers 
for  the  best  interests  of  the  patients  in  general  or  the  particular  in- 
dividual or  his  condition,  disease,  or  injury.     In  any  event  the  best 
possible  attention  and  medical  skill  should  be  provided.     In  the  main 
patients  should  be  admitted  to  the  naval  hospital  until  the  limit  of 
capacity  is  reached.     There  should  be  provisions  made,  however,  for 
evacuation  of  beds  in  order  that  there  may  be  beds  available  for 
emergencies  not  foreseen  or  expected.     Every  effort  should  be  made 
to  segregate  and  isolate  the  various  types  of  contagious  disease. 


GOVERNMENT  OF   NAVAL  DISTRICTS.  17 

Disposition  of  patients  from  the  naval  hospital  base  should  be 
under  the  direction  of  the  medical  director  and  may  be  made  to 
duty,  to  opportunities  for  convalescents,  to  sick  leave,  to  patients 
own  home  for  leave,  to  a  special  institution  for  care  and  special  treat- 
ment or  desirable  environment  for  cure,  or  such  other  disposition 
as  is  necessary,  the  usual  regulations  in  such  matters  being  followed. 

All  naval  patients  though  disposed  of  locally  for  treatment  will 
be  officially  regarded  as  attached  to  and  under  the  rules  and  regula- 
tions of  the  established  naval  hospital  and  under  the  command  of 
the  medical  director  in  command  of  the  naval  hospital. 

MEDICAL  RECORDS. 

28.  The  medical  director  shall  insure  the  observance  of  all  provi- 
sions required  by  the  Navy  Regulations  and  Instructions  and  the 
Manual  for  the  Medical  Department  for  the  preparation,  verifica- 
tion, custody,  and  disposition  of  health  records  and  service  records,, 
and  for  making  of  proper  entries  in  pay  accounts,  etc.,  statistical 
reports  and  returns  for  all  patients  cared  for  by  the  hospital  service 

1  cither  at  the  naval  hospital  or  at  any  Public  Health  Service  sta- 
tion, Red  Cross  hospital,  civic  institution,  or  elsewhere  under  the 
supervision  of  his  offices  and  officers.  The  offices  of  the  medical 
director  at  the  naval  hospital  will  have  custody  of  all  records,  offi- 
cial and  unofficial  correspondence,  statistical  reports  and  returns,  and 
the  preparation  and  forwarding  thereof.  Supervisors  of  sick  will 
be  held  responsible  for  the  care  and  comfort  of  all  patients  under 
their  charge,  the  custody  and  the  making  of  proper  entries  in  all 
health  records,  reports  of  medical  survey,  statements  as  to  the  condi- 
tion of  pateints,  statements  or  lists  of  patients  by  name,  rate,  sta- 
tion, diagnosis,  and  disposition  in  form  of  a  report  to  the  medical 
director,  reports  for  incorporation  in  the  naval  hospital's  returns 
on  Forms  F,  G,  H,  I,  K,  M,  N,  and  P  in  the  case  of  all  patients  under 
his  supervision  and  control. 

The  medical  director,  upon  receipt  of  all  data  from  his  officers,, 
shall  require  to  be  prepared  the  regular  reports  and  returns  usually 
made  by  the  hospital,  incorporating  all  patients,  however  distributed 
or  disposed  of  and  regarded  as  attached  to  the  naval  hospital  base 
in  these  returns,  as  if  these  patients  were  housed  and  under  treat- 
ment in  the  regular  naval  hospital  establishment. 

TRA  N  SPORTATION . 

29.  Every  provision  should  be  made  for  the  transportation  not  only 
of  patients  arriving  for  disposition  to  hospital  but  also  of  those- 
to  be  distributed  or  exchanged  among  the  various  adjuncts  and  units. 


18  GOVERNMENT  OF   NAVAL  DISTBICTS. 

of  the  naval  hospital  base.  There  should  be  prepared  a  list  of 
sources  of  supply  of  vehicles,  ambulances,  trucks,  etc.,  which  may  be 
called  upon  or  commandeered  in  emergency  to  meet  the  requirements 
of  this  transportation  service.  Cooperation  with  the  medical  aid 
in  this  service  should  be  had  with  a  view  to  the  expeditious  and  suit- 
able disposition  of  patients  at  the  time  of  arrival  at  the  distributing 
station.  The  use  of  the  ambulances  of  the  naval  and  adjunct  hospi- 
tals, or_of  private  ownership,  or  the  requisitioning  for  additional 
ambulances  for  the  naval  hospital  itself  should  be  judiciously  con- 
sidered and  determined. 

QUARANTINE. 

30.  In  matters  of  quarantine,  fumigation  and  disinfection,  combat- 
ing epidemics,  etc.,  the  facilities  of  the  Public  Health  Service  will  be 
utilized  when  practicable  and  necessary;  special  arrangements  and 
directions  in  each  case  to  be  obtained  through  the  Bureau  of  Medi- 
cine and  Surgery. 

SANITATION. 

31.  Supplies  of  fresh  water  should  be  obtained  only  from  reliable 
and  inspected  sources.     The  United  States  Public  Health  Service 
maintains  an  inspection  and  examination  service  and  has  on  file  and 
readily  available  reliable  information  concerning  the  water  supply 
of  nearly  all  communities.     Special  request  should  be  made  to  the 
Surgeon  General,  United  States  Public  Health  Service,  via  Bureau 
of  Medicine  and  Surgery  for  this  information. 

RECORDS,  ETC. 

32.  See  under  dispensary  service  and  hospital  service  for  instruc- 
tions relative  to  records  in  the  hands  of  each  division  of  medical 
.service. 

Copies  of  all  instructions  and  regulations  issued  and  pertaining  to 
the  activities  of  the  dispensary  and  hospital  services,  patrol  boats, 
.coast  defense  forces,  etc.,  should  be  forwarded  to  the  Bureau  of 
Medicine  and  Surgery  for  information  and  file.  Suggested  changes 
or  revisions  or  additions  to  this  manual  will  receive  careful  con- 
sideration. 

(INCLOSURE  A.) 

Correspondence  relative  to  cooperation  of  the  United  States  Public 
Health  Service  with  the  Medical  Department  of  the  Navy  in  time  of 
threatened  or  actual  war. 

MABCH  23,  1917. 

SIK  :  The  Navy  Department  desires  to  take  up  the  question  of  the  possibility 

.of  the  Medical  Department  of  the  Navy  availing  itself  of  the  facilities  to  be 

had  at  certain  hospitals  and  quarantine  stations  of  the  United  States  Public 


GOVERNMENT   OP   NAVAL  DISTRICTS.  19 

Health  Service  for  the  care  and  treatment  (even  if  no  more  than  temporary)  of 
sick  and  wounded  from  ships  of  the  Navy  on  coast-defense  duty  when  a  naval 
hospital  is  not  convenient  or  available. 

The  act  of  July  1,  1902,  section  4,  provided  "  That  the  President  is  authorized, 
in  his  discretion  to  utilize  the  Public  Health  and  Marine-Hospital  Service 
in  times  of  threatened  or  actual  war  to  such  extent  and  in  such  manner  as 
shall,  in  his  judgment,  promote  the  public  interest  without,  however,  in  any 
wise  impairing  the  efficiency  of  the  service  for  the  purposes  for  which" the  same 
was  created  and  is  maintained." 

Therefore  it  is  desired  that  the  Medical  Department  of  the  Navy  be  author- 
ized to  direct  the  transfer  of  such  sick  and  wounded  patients  to -the  nearest 
hospital  or  quarantine  station  of  the  United  States  Public  Health  Service  when 
emergency  or  urgent  necessity  demands. 

It  is  further  desired  that  when  naval  patients  are  received  in  United  States 
Public  Health  hospitals  or  quarantine  stations  that  the  health  records,  sick 
reports,  medical  surveys,  etc.,  be  kept  and  made  out  by  officers -of  the  United 
States  Public  Health  Service  attached  to  the  hospital  or  quarantine  station, 
such  officers  to  be  directed  by  proper  authority  to  assist  in  the  proper  execution 
of  Navy  and  Marine  Corps  medical  records.  Records,  reports,  surveys,  etc., 
would  be  forwarded  to  the  Bureau  of  Medicine  and  Surgery  according  to 
instructions  in  the  Manual  for  the  Medical  Department  or  in  accordance  with 
such  other  instructions  as  may  be  issued  from  time  to  time. 

Bills  and  expenses  incurred  in  caring  for  these  patients  to  be  adjusted  in  the 
usual  manner  between  governmental  departments. 

If  this  plan  is  approved,  it  is  desired  that  an  officer  of  the  United  States 
Public  Health  Service  be  detailed  to  confer  with  the  Bureau  of  Medicine  and 
Surgery,  and  it  is  further  desired  that  the  Bureau  of  Medicine  and  Surgery  be 
furnished  with  the  location,  character,  number  of  beds,  operating  facilities, 
and  limit  of  expansion  of  these  hospitals  or  quarantine  stations. 
Respectfully, 


Secretary  of  the  Navy. 
The  SECRETABY  OF  THE  TREASURY, 

Treasury  Department,  Washington,  D.  C. 

TREASURY  DEPARTMENT, 
OFFICE  OF  THE  SECRETARY, 

Washington,  March  2Jf,  1917. 
The  SECRETARY  OF  THE  NAVY. 

SIR  :  I  have  the  honor  to  acknowledge  receipt  of  your  letter  dated  March  23, 
1917,  stating  that  your  department  desires  to  take  up  the  question  of  the  possi- 
bility of  the  Medical  Department  of  the  Navy  availing  itself  of  the  facilities  to 
be  had  at  certain  hospitals  and  quarantine  stations  of  the  United  States  Public 
Health  Service  for  the  care  and  treatment  of  sick  and  wounded  from  ships  of 
the  Navy,  under  the  act  of  July  1,  1902,  section  4,  which  provides  that  that 
service  may  be  utilized  in  times  of  threatened  or  actual  war.  It  is  further 
noted  that  it  is  desired  that  the  Medical  Department  of  the  Navy  be  authorized 
to  direct  the  transfer  of  sick  and  wounded  patients  to  the  nearest  hospital  or 
quarantine  station  of  the  Public  Health  Service  if  any  emergency  or  urgent 
necessity  demands,  and  that  the  health  records,  sick  reports,  and  medical  sur- 
veys of  such  sick  and  wounded  patients  to  be  kept  and  made  out  by  officers 
of  the  United  States  Public  Health  Service. 

In  reply,  I  have  to  state  that  this  department  will  cooperate  with  the  Navy 
Department  by  placing  the  utilities  of  the  Public  Health  Service  as  well  as  the 


20  GOVERNMENT  OF   NAVAL  DISTRICTS. 

services  of  its  medical  officers  at  the  disposal  of  your  department,  and  in  con- 
sonance with  the  request  contained  in  the  last  paragraph  of  your  letter  a  com- 
missioned medical  officer  of  the  Public  Health  Service  has  been  detailed  to  con- 
fer with  the  Bureau  of  Medicine  and  Surgery  with  a  view  to  carrying  out  the 
requests  contained  in  your  letter. 
Respectfully, 

BYBON  R.  NEWTON,  Acting  Secretary. 


(INCLOSURE  B.) 

EXECUTIVE  ORDER. 

Under  the  authority  of  the  act  of  Congress  approved  July  1,  1902,  and 
subject  to  the  limitations  therein  expressed,  it  is  ordered  that  hereafter  in 
times  of  threatened  or  actual  war  the  Public  Health  Service  shall  consti- 
tute a  part  of  the  military  forces  of  the  United  States,  and  in  times  of 
threatened  or  actual  war  the  Secretary  of  the  Treasury  may,  upon  request 
of  the  Secretary  of  War  or  the  Secretary  of  the  Navy,  detail  officers  or 
employees  of  said  service  for  duty  either  with  the  Army  or  the  Navy.  All 
the  stations  of  the  Public  Health  Service  are  hereby  made  available  for 
the  reception  of  sick  and  wounded  officers  and  men,  or  for  such  other 
purposes  as  shall  promote  the  public  interest  in  connection  with  military 
operations. 

WOODKOW  WILSON. 

THE  WHITE  HOUSE,  April  3,  1917. 


(INCLOSURE  C.) 

COOPERATION     WITH    THE    NAVY    DEPABTMENT. 

Unnumbered  bureau  circular  lettter. 

TREASURY  DEPARTMENT, 

UNITED  STATES  PUBLIC  HEALTH  SERVICE, 

Washington,  April  14,  1917. 
To  Medical  Officers  in  Charge 

First,  Second,  and  Third  Class  Stations, 

United  States  Public  Health  Service. 

There  are  forwarded  to  you  under  separate  cover  a  copy  of  the  Manual 
for  the  Medical  Department  of  the  United  States  Navy,  together  with  amend- 
ments thereto,  a  Nomenclature  of  Diseases  and  Injuries  used  by  the  Navy 
Department,  and  certain  health  records  and  blank  forms  of  the  Medical 
Department  of  the  Navy. 

The  Secretary  of  the  Navy  has  requested  that  officers  of  the  service  be- 
come familiar  with  the  directions  given  in  the  manual,  particularly  chap- 
ters 6,  8,  13,  16,'  17,  18,  24,  and  25,  and  that  the  forms  be  used  in  keeping 
the  records  of  the  sick  and  injured  of  the  Navy  who  may  be  admitted  to 
your  station  under  paragraph  463  of  the  Service  Regulations,  1913.  You 
are  directed  to  comply  with  the  request  of  the  Secretary  of  the  Navy  and 
to  instruct  the  officers  at  your  station  in  the  manual  and  the  use  of  the 
blanks;  also  to  take  up  the  manual  and  amendments  thereto  on  the  station 
property  return. 


GOVERNMENT  OF    NAVAL  DISTRICTS.  21 

All  communications  with  the  Navy  Department  should  be  forwarded  through 
the  bureau.  A  rubber  stamp  of  identification  for  marking  these  papers  in 
the  upper  right  hand  corner  will  be  sent  you  in  a  few  days. 

You  are  directed  to  acknowledge  the  receipt  of  this  letter. 

RUPERT  BLUE,  Surgean  General. 


(INCLOSTJRE  D.) 

UNITED  STATES  COAST  QUAED. 

Officers  of  the  Public  Health  Service  are  detailed  to  duty  aboard 
vessel  of  the  Coast  Guard  by  direction  of  the  Secretary  of  the  Treas- 
ury upon  the  request  of  the  Secretary  of  the  Navy,  in  accordance 
with  the  Executive  order  of  the  President  of  April  3,  1917  (see  In- 
closure  B). 

The  procedure  followed  in  obtaining  supplies  for  marine  hospitals 
and  quarantine  stations  is  as  follows : 

Subsistence. — If  supplies  contracted  for  by  the  General  Supply 
Committee  are  needed  in  quantities  of  100  pounds  or  more,  they  are 
ordered  direct  from  the  contractors  listed  in  the  general  schedule  of 
supplies;  if  in  quantities  of  less  than  100  pounds,  requisition  can  be 
made  upon  the  purveying  depot  at  Washington,  D.  C.,  which  will 
ship  the  articles  needed.  Supplies  not  contracted  for  by  the  General 
Supply  Committee  may  be  bought  on  quarterly  proposals,  approved 
by  the  bureau,  or  on  yearly  contract  with  formal  bond,  approved  by 
the  Secretary  of  the  Treasury.  When  these  are  not  obtainable,  pur- 
chases are  made  in  open  market  at  the  lowest  prices  for  satisfactory 
supplies. 

Equipment. — Regular  requisitions  for  equipment  needed  are  sub- 
mitted to  the  bureau  semiannually.  Special  requisitions  are  sub- 
mitted from  time  to  time  as  occasion  demands.  If  the  articles  needed 
are  listed  in  the  general  schedule  of  supplies,  the  station  is  authorized 
to  buy  direct  f  i/om  the  contractor,  provided  the  weight  of  the  ship- 
ment from  the  contractor  aggregates  100  pounds  or  more.  If  the 
weight  of  the  shipment  is  less  than  100  pounds,  the  articles  are 
ordered  and  shipped  by  the  purveying  depot  at  Washington.  If  the 
articles  needed  are  not  on  the  general  schedule  of  supplies,  the  sta- 
tions are  authorized  to  solicit  competitive  proposals  by  advertising 
and  submit  them  to  the  bureau  with  recommendation  for  approval. 
Proposals  for  equipment  not  on  the  general  schedule  of  supplies 
under  $100  are  approved  by  the  Surgeon  General;  proposals  in 
amount  of  $100  or  more  are  approved  by  the  Secretary  of  the  Treas- 
ury. Articles  of  equipment  immediately  needed  may  be  bought  by 
the  stations  without  bureau  authority  under  the  law  and  regulations 
governing  exigency  purchases,  and  vouchers  to  cover  submitted  to 


22  GOVERNMENT  OF   NAVAL  DISTRICTS. 

the  bureau  for  approval  and  payment.  (Abstract  from  letter  from 
the  Surgeon  General,  United  States  Public  Health  Service,  May  21, 
1917,  on  file  in  Bureau  of  Medicine  and  Surgery.) 


(ENCLOSURE  E.) 

UNITED  STATES  COAST  AND  GEODETIC  SURVEY. 

Surgeons  in  the  service  of  the  United  States  Coast  and  Geodetic 
Survey  are  appointed  by  the  Secretary  of  Commerce,  upon  recom- 
mendation of  the  Superintendent  of  the  Survey,  after  selection  from 
a  certificate  of  eligibles  from  the  United  States  Civil  Service  Com- 
mission, Washington.  Applicants  residing  in  the  Philippine  Islands 
may  be  certified  through  the  Philippine  Civil  Service  Board,  Manila, 
P.  I.,  provided  they  have  been  examined  by  that  board.  Appli- 
cants are  required  to  show  that  they  are  graduates  from  medical 
schools  of  recognized  standing  and  must  pass  the  same  physical 
examination  as  that  prescribed  for  positions  in  the  United  States 
Public  Health  Service. 

The  number  of  surgeons  in  the  Coast  and  Geodetic  Survey  actually 
employed  under  pay  at  any  time  is  nine.  Four  of  these  are  employed 
in  Alaska  and  on  the  Pacific  coast,  four  in  the  Philippines,  and  one 
on  the  Atlantic  coast  and  Porto  Rico.  All  surgeons  are  attached  to 
vessels  of  the  Survey. 

The  salaries  of  these  surgeons  are  paid  from  a  lump-sum  appro- 
priation made  by  Congress  to  man  and  equip  vessels  of  this  service. 
The  employment  of  these  surgeons  may  be  terminated  by  furlough 
without  pay  at  any  time  according  to  the  exigencies  of  the  service. 

Surgeons  are  frequently  employed  for  temporary  duty  on  board 
vessels  of  this  service  during  the  Alaska  surveying  season,  at  the 
close  of  which  their  services  are  discontinued.  Such  appointments 
are  made  through  the  Civil  Service  Commission  in  the  manner  out- 
lined above. 

This  service  maintains  no  dispensaries  for  the  treatment  of  the 
ship's  officers  or  the  crew  of  vessels.  The  benefits  of  the  United 
States  Public  Health  Service  are  extended  to  cover  cases  requiring 
hospital  treatment.  On  shipboard  all  officers  and  employees  are 
entitled  to  the  services  of  the  ship's  surgeon  and  the  ship's  medical 
supplies. 

The  medical  supplies  are  obtained  by  requisition  on  the  Navy 
Department.  Requisitions  are  made  on  Form  B  of  the  Navy  De- 
partment by  the  surgeon  of  the  vessel  and,  after  approval  by  his 
commanding  officer,  are  forwarded  to  the  Superintendent  of  the 
Coast  and  Geodetic  Survey  for  administrative  examination  to  insure 


GOVERNMENT   OF    NAVAL  DISTRICTS.    *  23 

proper  economy,  after  which  they  are  forwarded  to  the  Bureau  of 
Medicine  and  Surgery,  Navy  Department.  The  amount  requisi- 
tioned is  based  on  the  latest  edition  of  the  Navy  Medical  Supply 
Table.  Necessary  articles  not  included  in  the  supply  table  are 
purchased  by  the  commanding  officer  in  the  open  market  on  competi- 
tive bids. 

There  are  seven  surgeons  in  the  service  now  under  pay.  The 
longest  continuous  service  of  any  one  in  that  corps  covers  a  period 
of  17  years. 

Surgeons  are  assigned  or  transferred  to  or  from  vessels  of  the 
Coast  and  Geodetic  Survey  by  order  of  the  superintendent. 

Newly  appointed  surgeons  assigned  to  survey  vessels  in  the  Philip- 
pines are  obligated  to  serve  a  period  of  two  years.  This  is  done  to 
insure  the  Government  against  loss  of  service  after  having  paid 
transportation  from  the  United  States  to  the  Philippine  Islands. 


(INCLOSURE  I.) 

UNITED  STATES  PUBLIC  HEALTH  STATIONS  HAVING  COMPLETE  FACILI- 
TIES FOR  DISINFECTION,  FUMIGATION,  DERATIZATION,  ETC.,  OF  SHIPS. 

The  following  data  is  furnished  as  to  the  capacity  and  availability 
of  the  various  quarantine  stations  of  the  Public  Health  Service  in 
respect  to  the  fumigation  and  disinfection  of  Navy  vessels. 

Portland,  Me.,  quarantine  station. — This  'station  is  located  on 
House  Island  in  Portland  Harbor,  about  one-fourth  mile  from  the 
city.  .Vessels  subject  to  quarantine  treatment  are  furnished  ample 
anchorage  in  Casco  Bay.  The  depth  of  water  at  the  wharf  is  not 
sufficient  for  ships  to  go  alongside.  There  are  hospital  facilities  for 
10  patients  and  detention  barracks  for  the  accommodation  of  46 
persons.  Detention  barracks  with  a  capacity  of  300  persons  are  now 
being  constructed  and  will  probably  be  available  within  one  year. 
While  the  detention  and  hospital  facilities  are  somewhat  restricted, 
the  disinfecting  and  fumigating  equipment  is  sufficient  for  the  treat- 
ment of  vessels  of  any  size. 

Boston,  Mass.,  quarantine  station. — This  station  is  located  on  Gal- 
lops Island,  about  6  miles  from  the  city.  Alongside  the  wharf  there 
is  a  depth  of  water  of  13  feet  at  low  tide  and  22  feet  at  high  tide; 
A  short  distance  from  the  wharf,  however,  vessels  of  greater  draft 
can  secure  safe  and  sufficient  anchorage.  There  are  hospital  facili- 
ties at  this  station  for  65  patients.  The  capacity  of  the  barracks 
for  the  detention  of  contacts  or  suspects  is  600  persons.  The  dis- 
infecting and  fumigating  equipment  is  sufficient  for  vessels  of  any 
size.  There  are  also  shower  baths  and  steam  chambers  for  the  dis- 
infection of  clothing  and  personal  effects. 


24  GOVERNMENT   OF    NAVAL  DISTRICTS. 

Providence,  R.  /.,  quarantine  station. — At  Providence  the  disin- 
fecting equipment  and  detention  facilities  are  located  on  a  floating 
plant,  and  vessels  of  any  size  can  anchor  in  the  stream  alongside. 
The  isolation  facilities  on  the  hulk  are  sufficient  only  for  5  persons, 
and  the  accommodations  for  contacts  or  suspects  are  limited  to  100 
persons.  Vessels  of  any  size  can  be  fumigated  or  disinfected  at  this 
station,  and  clothing  and  personal  effects  can  be  disinfected  in  steam 
chambers  located  on  the  floating  plant. 

Reedy  Island,  Del.,  quarantine  station. — This  station  is  located 
about  the  center  of  Reedy  Island  in  the  Delaware  River  and  is 
distant  from  Delaware  City  about  6  miles  and  from  Port  Penn  about 
one-half  mile.  Vessels  with  a  draft  of  30  feet  or  under  can  come 
alongside  the  wharf.  The  capacity  of  the  barracks  for  the  detention 
of  suspects  is  865  persons.  The  hospital  capacity  is  sufficient  for  20 
or  30  patients.  Vessels  of  any  size  can  be  fumigated  or  disinfected. 

Delaware  Breakwater,  Del.,  quarantine  station. — This  station  is 
located  on  Delaware  Bay  just  within  Cape  Henlopen  and  on  the 
south  side  of  the  bay.  The  station  is  distant  from  the  town  of 
Lewes,  Del.,  about  2|  miles,  and  from  Philadelphia  about  116  miles. 
There  are  no  dock  or  wharf  facilities  at  this  station.  It  is  under- 
stood that  there  is  safe  anchorage  in  the  bay  for  the  largest  vessels, 
and  personnel  can  be  disembarked  at  a  small  pier  near  the  station. 
There  are  hospital  facilities  for  35  patients  and  detention  facilities 
for  500  persons.  In  addition,  there  is  a  small  hospital  for  the  isola- 
tion of  contagious  diseases,  with  a  capacity  of  6  patients.  The 
fumigating  and  disinfecting  equipment  is  sufficient  for  vessels  of  any 
size,  and  there  are  also  steam  chambers  for  the  disinfection  of  cloth- 
ing and  personal  effects. 

Cape  Charles,  Va.,  quarantine  station. — This  station  is  located  at 
Old  Point.  Vessels  are  disinfected  and  fumigated  at  anchorage  in 
Hampton  Roads,  and  the  equipment  for  this  purpose  is  ample  for 
vessels  of  any  size.  There  are  no  facilities,  however,  for  the  deten- 
tion of  persons  in  quarantine  other  than  on  the  vessel  treated. 

Charleston,  S.  C.,  quarantine  station. — This  station  is  located  on 
the  north  end  of  James  Island,  Charleston  Harbor,  about  3  miles 
from  the  city  of  Charleston.  Vessels  with  a  draft  of  22  feet  can  go- 
alongside  the  wharf.  For  vessels  of  a  greater  draft  safe  anchor- 
age is  available  nearby.  There  are  accommodations  on  the  station 
for  the  detention  of  90  persons  and  hospital  facilities  for  the  care  of 
8  patients.  The  equipment  is  ample  for  the  disinfection  and  fumi- 
gation of  vessels  of  any  size.  There  are  steam  chambers  for  the  dis- 
infection of  clothing  or  personal  effects  on  the  station. 

Savannah,  Ga.,  quarantine  station. — This  station  is  located  on 
Cockspur  Island  in  Savannah  River,  about  15  miles  below  the  city 
of  Savannah.  The  depth  of  water  alongside  the  wharf  is  20  feet. 


GOVERNMENT   OP    NAVAL  DISTRICTS.  25 

Vessels  of  a  greater  draft  can  anchor  in  the  river  nearby.  There  are 
hospital  accommodations  for  12  to  15  patients  and  detention  facili- 
ties for  contacts  or  suspects  sufficient  for  40  persons.  There  are  ade- 
quate facilities  for  the  disinfection  and  fumigation  of  vessels  of  any 
size,  also  steam  chambers  for  the  disinfection  of  clothing  and  per- 
sonal effects. 

Cape  Fear,  N.  C.,  quarantine  station. — This  station  is  located  on 
piling  in  the  Cape  Fear  River,  just  off  Southport.  Alongside  the 
wharf  there  is  a  depth  of  water  of  26  feet.  Vessels  of  greater  draft 
can  secure  safe  anchorage  nearby.  The  hospital  capacity  is  18  pa- 
tients. The  barracks  for  the  accommodation  of  suspects  or  contacts 
will  hold  50  persons.  The  fumigating  and  disinfecting  equipment 
is  ample  for  vessels  of  any  size.  There  are  also  steam  sterilizing 
chambers  for  the  disinfection  of  clothing  or  personal  effects. 

Tampa  Bay,  Fla.,  quarantine  station. — This  station  is  located  on 
Mullet  Key,  about  11  miles  south  of  St.  Petersburg,  Fla.,  and  35 
miles  from  Tampa.  The  depth  of  water  alongside  the  wharf  is  suf- 
ficient for  vessels  of  19  feet  draft.  The  anchorage  nearby  is  ample 
for  vessels  of  any  draft  and  is  safe.  There  are  hospital  facilities  at 
the  station  to  accommodate  8  patients.  The  detention  barracks  will 
provide  for  36  persons.  Vessels  of  any  size  can  be  fumigated  or  dis- 
infected, and  there  are  also  steam  sterilizing  chambers  for  the  disin- 
fection of  clothing  and  effects. 

Pensacola,  Fla.,  quarantine  station. — This  station  is  located  in 
Santa  Rosa  Sound,  on  the  north  side  of  Santa  Rosa  Island,  about  7 
miles  from  the  city  of  Pensacola.  There  is  a  depth  of  water  along- 
side the  wharf  of  22  feet  and  a  safe  anchorage  for  vessels  of  greater 
draft  nearby.  Vessels  of  any  size  can  be  disinfected  or  fumigated 
at  this  station.  There  are  also  steam  sterilizing  chambers  for  the 
disinfection  of  clothing  and  personal  effects. 

Mobile,  Ala.,  quarantine  station. — This  station  is  located  at  the  en- 
trance to  Mobile  Bay,  near  Fort  Morgan.  There  is  no  anchorage 
alongside  the  wharf,  but  there  is  ample  and  safe  anchorage  for  ves- 
sels of  any  size  nearby.  The  disinfecting  and  fumigating  facilities 
are  ample  for  vessels  of  any  size.  There  are  accommodations  for  65 
suspects  or  contacts. 

New  Orleans,  La.,  quarantine  station. — This  station  is  located  on 
the  Mississippi  River  about  90  miles  below  New  Orleans.  There  is 
a  depth  of  water  alongside  the  wharf  of  30  feet.  The  hospital 
capacity  is  30  patients.  The  detention  barracks  will  accommodate 
200  suspects  or  contacts.  The  equipment  for  fumigation  and  disin- 
fection of  vessels  of  any  size  is  ample.  The  station  is  equipped  with 
steam-sterilizing  chambers  for  the  disinfection  of  clothing  and  per- 
sonal effects. 


26  GOVERNMENT  OP   NAVAL  DISTRICTS. 

Galveston,  Tex.,  quarantine  station. — This  station  is  located  on 
Pelican  Spit,  about  2  miles  from  Galveston.  The  depth  of  water 
alongside  the  wharf  is  25  feet.  Vessels  of  greater  draft  can  anchor 
nearby.  There  is  ample  equipment  for  the  fumigation  and  disinfec- 
tion of  vessels  of  any  size.  There  are  also  steam  sterilizing  chambers 
for  the  disinfection  of  clothing  or  personal  effects.  There  are  beds 
for  15  patients  in  the  hospital,  and  the  detention  barracks  will  ac- 
commodate TO  persons. 

San  Diego,  Cal.,  quarantine  station. — This  station  is  located  on  the 
west  side  of  the  harbor,  to  the  north  of  the  entrance,  about  4  miles 
from  Point  Loma  and  7  miles  from  the  city  of  San  Diego.  The  depth 
of  water  alongside  the  wharf  is  22  feet,  and  there  is  sufficient  anchor- 
age in  the  bay  nearby  for  vessels  of  any  size.  The  hospital  has  a 
capacity  of  18  patients,  and  the  detention  barracks  will  accommodate 
80  suspects  or  contacts.  There  is  ample  equipment  for  fumigating  or 
disinfecting  vessels  of  any  size,  including  steam  sterilizing  chambers. 

San  Francisco,  Col.,  quarantine  station. — This  station  is  located 
on  the  north  side  of  Angel  Island,  in  San  Francisco  Bay,  about  6 
miles  distant  from  San  Francisco  and  1  mile  from  Tiburon.  The 
depth  of  water  alongside  the  wharf  is  19  feet,  and  there  is  ample 
and  safe  anchorage  for  vessels  of  larger  size  in  the  adjacent  harbor. 
The  hospital  will  accommodate  45  patients.  The  accommodations 
for  suspects  or  contacts  are  sufficient  for  about  350  persons.  There 
is  ample  equipment  for  fumigating  or  disinfecting  vessels  of  any  size, 
also  steam  sterilizing  chambers. 

Columbia  River,  Ore.,  quarantine  station. — This  station  is  located 
on  the  north  shore  of  Columbia  River,  opposite  the  city  of  Astoria, 
about  12  miles  from  the  mouth  of  the  river.  The  depth  of  water 
alongside  the  wharf  is  24  feet,  with  anchorage  for  vessels  of  greater 
draft  in  the  river  nearby.  At  this  station  vessels  of  any  size  can  be 
fumigated  or  disinfected,  the  equipment  including  steam  sterilizing 
chambers.  There  are  hospital  facilities  for  20  patients,  and  the 
detention  barracks  will  accommodate  54  suspects  or  contacts. 

Port  Townsend,  Wash.,  quarantine  station. — This  station  is  located 
on  Diamond  Point,  on  the  west  shore  of  Discovery  Bay,  Puget 
Sound,  about  12  miles  from  Port  Townsend.  Alongside  the  wharf 
the  depth  of  water  is  30  feet.  The  hospital  capacity  is  26  patients, 
and  the  detention  barracks  can  accommodate  661  persons.  Vessels 
of  any  size  can  be  fumigated  or  disinfected.  The  equipment  also 
includes  steam  sterilizing  chambers. 

Honolulu,  Hawaii,  quarantine  station. — This  station  is  located  in 
the  harbor  of  Honolulu  near  the  city.  There  are  accommodations 
for  the  housing  of  1,000  suspects  or  contacts  and  hospital  facilities 
for  the  care  of  31  patients.  Vessels  of  any  size  can  be  fumigated  or 


GOVERNMENT  OF   NAVAL  DISTRICTS.  27 

V 

disinfected,  and  the  equipment  includes  steam  sterilizing  chambers 
for  the  disinfection  of  clothing  and  personal  effects. 

Mariveles,  P.  /.,  quarantine  station. — This  station  is  located  at  the 
entrance  to  Manila  Harbor,  Manila  Bay,  opposite  Corregidor.  The 
depth  of  water  alongside  the  wharf  is  26  feet,  with  ample  and  secure 
anchorage  near  by  for  vessels  of  any  size.  There  are  hospital  accom- 
modations for  40  patients  and  detention  facilities  for  1,200  persons. 
The  fumigation  and  disinfection  facilities  are  ample  for  vessels  of 
any  size.  The  entire  personnel  of  Army  transports  have  frequently 
been  treated  at  this  station,  which  is  an  exceptionally  well-equipped 
plant. 

San  Juan,  P.  R.,  quarantine  station. — This  station  is  located  on 
the  island  of  Miraflores,  in  San  Juan  Bay.  It  is  necessary  for  ves- 
sels to  anchor  about  one-fourth  mile  from  the  quarantine  station  in 
order  to  secure  sufficient  and  safe  anchorage  for  vessels  of  any  size. 
The  facilities  are  sufficient  for  the  fumigation  or  disinfection  of  any 
size  vessel,  and  include  steam  sterilizing  chambers  for  the  disinfec- 
tion of  personal  effects  and  clothing.  There  are  hospital  accommoda- 
tions for  12  patients.  The  capacity  of  the  detention  barracks  is 
sufficient  for  75  suspects  or  contacts. 

In  general  it  may  be  stated  that  for  the  treatment  of  the  larger 
size  naval  vessels  the  stations  at  Boston,  Reedy  Island,  Charleston, 
Tampa  Bay,  Pensacola,  New  Orleans,  San  Francisco,  Port  Townsend, 
Honolulu,  Mariveles,  and  San  Juan  should  be  selected  as  having  the 
more  ample  accommodations  for  the  detention  of  personnel  and 
equipment  for  disinfection.  (Copy  of  letter  from  Surgeon  General, 
United  States  Public  Health  Service,  June  12,  1917.) 


(INCLOSURB  J.) 

SPECIMEN  CONTRACT  FOR  USE  IN  CONNECTION  WITH  THE  USE  OF  FACILI- 
TIES OF  CIVIL  HOSPITALS,  ETC. 

N.  M.   S.   la.         REQUISITION    FOE    SEBVICES   OK    SUPPLIES     (ON    SHORE).  No.    10i. 

U.  S.  Naval  Hospital,  Portsmouth,  N.  H.,  May  26,  1917. 
To  the  Surgeon  General  U.  S.  Navy : 

The  following-named  services  or  articles  (which  latter  I  hereby  certify  are 
not  in  store  in  any  unreserved  stock,  or  obtainable  here  under  existing  con- 
tracts) are  required  for  maintenance  of  patients  in  excess  of  naval  accommo- 
dations and  will  be  absolutely  necessary  for  the  needs  stated,  immediately. 
Appro.  "8804  Hospital  Expenses  1917-1918." 

For  the  care,  maintenance,  and  treatment  of  naval  patients  in  other 
than  the  Naval  Hospital,  including  officers  and  enlisted  men  of  the 
Navy  and  Marine  Corps,  members  of  the  Nurse  Corps,  officers  and  en- 
listed men  of  the  Naval  Militia,  National  Naval  Volunteers,  Naval 
Reserve  Force,  and  other  Federal  services,  and  enrolled  women  when 
in  active  service  with  the  Navy : 

1.  For  care  of  officers  and  members  of  Navy  Nurse  Corps  and  en- 
rolled women   (noncontagious  cases) 


28 


GOVERNMENT   OF    NAVAL  DISTRICTS. 


2.  For  care  of  enlisted  men  (noncontagious  cases) 

3.  For  care  of  contagious  cases 

4.  Ambulance  service 

Specification:  Proposals  will  be  on  a  per  capita  per  diem  basis. 
NOTE. — Please  submit  bids  to  commanding  officer  for  recommendation 

as  to  award,  as  the  character  of  the  hospital,  its  location,  accessibility, 
and  ambulance  service  are  matters  of  equal  or  greater  importance  than 
the  price  bid. 

Total $1,000 

Bureau  of  Medicine  and  Surgery.  Bureau  of  Supplies  and  Accounts. 

Approved for  delivery.  Purchase  ordered 

B  f  Open  purchase.  Navy  Pay  Office : 

(.Advertisement.  Articles  marked 

:. Ordered  from  points  indicated 

Shipment  from 

BEPOBTS    OF    PUBCHASES. 
Date.      De(j^ery  Articles.  Amount. 


VOUCHEES  PASSED. 


Dealers. 


Date. 


Total 
amount. 


Pertaining 

to  this 
requisition. 


(INCLOSUEE  K.) 


A  PBOCLAMATION  BY   THE  PRESIDENT  OF   THE   UNITED    STATES. 


Whereas  the  American  National  Red  Cross  having  been  incorporated  by  an  act 
of  Congress  January  5,  1905,  "To  furnish  volunteer  aid  to  the  sick  and 
wounded  of  armies  in  time  of  war,  in  accordance  with  the  spirit  and  con- 
ditions of  the  treaty  of  Geneva  of  August  22,  1864  " ;  and 

Whereas  it  is  desirable  definitely  to  state  the  relations  that  shall  exist  between 
the  American  National  Red  Cross  and  the  military  departments  of  the  Gov- 
ernment in  the  event  of  war : 
Now,  therefore  I,  William  H.  Taft,  President  of  the  United  States,  by  virtue 

of  the  authority  in  me  vested,  do  hereby  declare  and  proclaim — 

1.  That  the  American  National  Red  Cross  is  the  only  volunteer  society  now 
authorized  by  this  Government  to  render  aid  to  its  land  and  naval  forces  in 
time  of  war. 

2.  That  any  other  society  desiring  to  render  similar  assistance  can  do  so 
only  through  the  American  National  Red  Cross. 

3.  That  to  comply  with  the  requirements  of  article  10  of  the  International 
Red  Cross  Convention  of  1906  (revision  of  the  treaty  of  Geneva),  that  part  of 


GOVERNMENT  OF    NAVAL  DISTRICTS.  29 

the  American  National  Red  Cross  rendering  aid  to  the  land  and  naval  forces 
will  constitute  a  part  of  the  sanitary  services  thereof. 

4.  That  should  it  be  desirable  in  time  of  war,  or  when  war  is  imminent,  for 
the  War  Department  or  the  Navy  Department  to  make  use  of  the  services  of 
the  American  National  Red  Cross,  the  Secretary  of  such  department  is  author- 
ized to  communicate  with  the  president  of  the  society,  specifying  the  char- 
acter of  the  services  required  and  designating  the  place  or  places  where  the 
personnel  and  material  will  be  assembled. 

5.  That  when  any  member  of  the  American  National  Red  Cross  reports  for 
duty  with  the  land  or  naval  forces  of  the  United  States,  pursuant  to  a  proper 
call,  he  will  thereafter  be  subject  to  military  laws  and  regulations  as  pro- 
vided in  article  10  of  the  International  Red  Cross  Convention  of  1906  and  will 
be  provided  with  the  necessary  certificate  of  identity. 

6.  That,  except  in  cases  of  great  emergency,  the  personnel  of  the  American 
National  Red  Cross  will  not  be  assigned  to  duty  at  the  front  but  will  be  con- 
fined to  hospitals  in  the  home  country,  at  the  base  of  operations,  on  hospital 
ships,'  and  along  lines  of  communication  of  the  military  and  naval  forces  of 
the  United  States. 

In  witness  whereof  I  have  hereunto  set  my  hand  and  caused  the  seal  of  the 
United  States  to  be  affixed. 

Done  at  the  city  of  Washington  this  22d  day  of  August,  A.  D.  1911,  ami  of 
the  Independence  of  the  United  States  of  America,  the  one  hundred  and  thirty- 
sixth. 

WM.  H.  TAFT. 


(INCLOSURE  L.) 

RECORDING  NAVAL  RESERVE  PERSONNEL   (ALL  CLASSES)    AND  SUPERNUMER- 
ARIES   (R.  &  P.  D.   127644,  4-30-17.) 

1.  Officers  and  enlisted  personnel  of  the  Naval  Reserve  (all  classes) 
when  on  active  duty,  and  National  Naval  Volunteers  (Naval  Militia) 
when  drafted  into  the  regular  service,  shall  be  treated  in  all  respects, 
for  record  purposes,  as  officers  and  enlisted  personnel  of  the  active 
force  of  the  Navy  and  shall  be  accounted  for  on  all  reports  and 
returns  as  such.    They  shall  be  designated  by  placing  after  the  grade 
or  rate,  wherever  used,  for  Naval  Reserve  "  NR  "  and  for  National 
Naval  Volunteers  "  NNV." 

2.  In  reporting  supernumeraries  indicate  a  retired  officer  or  man 
by  giving  grade  or  rate  followed  by  the  letters  "  RET  " ;  officers  and 
men  of  the  Naval  Auxiliary  Service  by  grade  or  rate  followed  by 
"  NAS  " ;  ex-service  personnel  by  the  letters  "  EX  "  followed  by  the 
grade  or  rate  previously  held;  members  of  the  Nurse  Corps  (female) 
by  "  Nurse  " ;  officer  and  men  of  the  Coast  Guard  Service  by  the  grade 
or  rate  followed  by  "  CGS  " ;  members  of  the  Lighthouse  Service  by 
their  titles  followed  by  "  LHS  " ;  members  of  other  naval  or  military 
organizations  by  grade  or  rate  followed  by  the  nationality  or  other 
indication ;  and  civilians  by  "  Civil." 


30  GOVERNMENT  OP   NAVAL  DISTRICTS. 

3.  The  term  "  super  "  for  supernumeraries  generally  has  not  been 
very  satisfactory  to  the  bureau  for  reference  purposes  and  by  close 
adherence  to  the  above  or  definite  designations  the  bureau  will  be  in 
possession  of  better  information  in  dealing  with  these  cases. 

GENERAL   INSTRUCTIONS    FOR    BLANK   FORMS     (PERSONNEL). 

4.  Ribbon  copies  (originals)  only  of  reports  and  returns  shall  be 
forwarded  to  the  department,  except  where  a  form  is  required  in 
duplicate  or  more  copies,  in  which  case  clear  carbon  copies  are  per- 
mitted as  the  duplicate,  or  seconds,  thirds,  etc. 

5.  No  form  shall  be  extended  by  attaching  pieces.    A  whole  addi- 
tional sheet  of  a  form  shall  be  used  when  necessary,  or  additional 
pieces  pasted  or  fastened  in  such  a  manner  so  as  not  to  increase  the 
original  size  of  the  form. 

6.  Economy  in  spacing  shall  be  exercised,  and,  when  not  specially 
ruled,  single-line  spacing  with  the  typewriter  should  always  be  used. 
Do  not  write  or  place  other  markings  in  spaces  when  no  information 
is  required.    Leave  them  blank. 

7.  All  reports  and  returns  shall  be  forwarded  at  the  time  re- 
quired, whether  there  is  anything  to  report  or  not.    Receipt  of  a 
form  with  no  information  at  least  informs  the  bureau  that  it  has 
not  been  overlooked  or  that  it  has  not  been  lost  in  the  mails. 

8.  Names. — Blank  forms,  letters,  and  telegrams,  generally,  which 
refer  to  personnel,  deal  primarily  with  the  individual,  and,  as  most 
all  forms  and  correspondence  are  filed  in  jackets,  under  the  name,  it 
is  imperative  that  the  Christian  name  or  names  and  surname  be 
spelled  out  in  full  as  far  as  possible. 

Owing  to  the  frequency  with  which  some  names  appear  in  the  files, 
it  is  at  times  impossible  to  differentiate  between  individuals  whose 
names  are  similar  when  only  the  surname  and  initials  are  given. 

9.  Grades  and  rates. — As  far  as  possible  the  grades  and  rates  of 
officers  and  enlisted  men  shall  be  spelled  out  in  full,  but  where  suf- 
ficient space  is  not  provided  abbreviations  shall  be  used. 


(INCLOSURE  M.) 

DEATHS  AND  DISPOSAL  OF  REMAINS. 

Any  deaths  that  may  occur  shall  be  reported  by  commanding  or 
medical  officers  to  the  Bureaus  of  Navigation  and  Medicine  and 
Surgery  by  separate  telegrams.  In  addition,  information  of  the  same 
shall  be  forwarded  to  the  nearest  relative  or  legal  representative  of 
the  deceased  if  the  address  of  such  person  can  be  obtained.  A  tele- 
gram may  be  used  for  this  if  deemed  expedient. 


GOVERNMENT  OF   NAVAL  DISTRICTS,  31 

In  the  case  of  officers  and  men  who  die  elsewhere  than  within  the 
United  States  the  amount  paid  for  funeral  expenses,  including  prep- 
aration, incasement,  and  interment  of  remains,  shall  not  exceed  $50 
each,  unless  due  regard  for  decent  burial  renders  greater  expense 
necessary,  which  fact  must  be  certified  on  all  copies  of  the  public  bills 
by  the  officer  ordering  payment  of  the  bill.  Such  bills  will  be  charge- 
able to  the  appropriation,  "  Contingent,  Medicine  and  Surgery." 

Annual  contracts  which  provide  for  funeral  expenses  for  the  per- 
sonnel of  the  Navy  and  Marine  Corps  will  be  availed  of  for  the 
necessary  and  proper  funeral  expenses  of  officers  and  men  of  the 
Naval  Auxiliary  Service  who  die  at  or  near  naval  stations  in  the 
United  States,  and  when  so  availed  of  the  public  bills  will  be  made 
by  the  hospital  or  the  medical  officer  of  the  station,  according  to  the 
terms  of  the  contract;  and  elsewhere  within  the  United  States  such 
expenses  will  be  allowed  upon  public  bills  duly  prepared  by  the 
master  as  a  charge  against  the  appropriation  "  Contingent,  Medi- 
cine and  Surgery,"  when  approved  by  the  Bureau  of  Medicine  and 
Surgery.  Full  information  relating  to  the  above-mentioned  annual 
contracts,  and  as  to  prompt  transfer  of  bodies  to  hospital  for  prepa- 
ration, incasement,  etc.,  and  other  proper  methods  of  procedure 
will  be  obtained  by  the  master  from  the  commanding  officer  of  the 
naval  hospital  or  the  medical  officer  of  the  station,  as  the  case  may  be. 

The  effects  of  the  deceased,  other  than  jewels,  trinkets,  keep- 
sakes, etc.,  may  be  sold  and  the  proceeds  of  the  sale  credited  to  the 
accounts  of  the  deceased;  the  express  charges  for  transportation  of 
such  effects  as  it  may  be  found  expedient  to  send  to  the  next  of 
kin  will  be  a  charge  against  "  Contingent,  Bureau  of  Navigation." 
When  the  next  of  kin  can  not  be  found  the  effects  of  any  value  shall 
be  sent  to  the  Bureau  of  Navigation. 

The  accounts  of  all  deceased  persons  shall  be  closed  as  soon  as 
possible  and  forwarded  to  the  Auditor  for  the  Navy  Department. 

Shipment  of  bodies  may  not  be  made  at  Government  expense  to 
a  point  beyond  the  continental  limits  of  the  United  States. 

Funeral  expenses  of  those  who  die  on  board  or  at  a  naval  hos- 
pital or  station,  and  when  burial  is  made  by  naval  authority,  are 
defrayed  by  Government,  but  when  the  funeral  arrangements  are 
assumed  by  relatives  or  friends  the  expenses  are  not  chargeable  to 
the  United  States.  (Dec.  Comp.,  Mar.  19,  1901.) 

The  expenses  for  the  service  of  a  chaplain  may  be  allowed  when 
the  services  of  a  Navy  chaplain  are  not  available,  and  will  be  a  charge 
against  the  appropriation  "  Contingent,  Medicine  and  Surgery." 
(Manual  for  Medical  Department,  par.  3454.) 


o 


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